The Ideal Medical Practices ProjectThe emerging role of the physician

Michigan Purchasers Health Alliance September 20, 2007

L. Gordon Moore MD Clinical Associate Professor University of Rochester Departments of Family

Medicine and Community and Preventive MedicineInstitute for Healthcare Improvement

IdealMedicalPractices.org

Funded by The Commonwealth Fund and the Physician’s

Foundation for Health Systems Excellence

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6.0%

8.0%

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3.2%3.2%3.2%2.8%

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1.9%1.9%2.3%

2.5%2.6%2.9%

4.1%4.4%

-2.0%

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2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Health Insurance PremiumsGeneral Inflation

Health Care Inflation

Health Care continues to grow far in excess of CPI

Primary Care Score vs. Health Care Expenditures, 1996

0

0.5

1

1.5

2

1000 1500 2000 2500 3000 3500 4000

Per Capita Health Care Expenditures

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Primary Care Score: 2 = StrongerFrom Barbara Starfield, MD

US

UK

SP

Entrenched Patterns

Institute of Medicine: Crossing the Quality Chasm

The problems come from poor systems … not bad people

“In its current form, habits, and environment, American health care is incapable of providing the public with the quality health care it expects and deserves.”

National Academy Press 2001

The perfect storm

• Cost of practice is rising

• Administrative burden is growing

• Pipeline of primary care supply is drying up

• Aging and burned out primary care work force

• Employer based primary care– Docs have more time with patients

• Best practice guidelines/protocols• Emphasis on health and wellness, prevention• Disease management for any with chronic conditions

– Improved access with worksite facilities– Refer to “high performance network of specialists”– Integrated EAP/chemical dependency

• Zastrow RJ, Quadracci L. Engaging Quad/Graphics Employees in the Improvement of Their Health and Healthcare Journal of Ambulatory Care Management, 29(3), 227-231

Quad-med results• Health care cost increases limited to 6.8%

during the last five years

• With Quad-Med, Quad/Graphics spends 17-20% less than Midwest average

• Superb HEDIS and employee satisfaction scores

PAGE ONE    February 11, 2005 Radical Surgery One Cure for High Health Costs: In-House Clinics at Companies By VANESSA FUHRMANS Staff Reporter of THE WALL STREET JOURNAL

Good Collaborative Care is A Good Thing

Wasson, Johnson, et al. JACM Vol. 29, No. 3, pp. 199–206

Past treatment has made:

Good collaborative

care

Poor collaborative

care pain much better 34.7% 9.6% emotional problems much better 34.8% 12.5%Pts with HTN, CAD, DM report their systolic BP<140 74.8% 64.6%Reports of problems from their medications 8.6% 20.1%Spent at least one day at home because of illness in past 3 months 26.9% 31.6%Physical or emotional problems limiting capactity to work in past 2 weeks 18.0% 33.4%Hospitalized in past year with common chronic diseases 12.3% 14.2%

Study of 25,000 Americans 19-69

Getting FocusCatching Your Breath

•Baseline Surveys•ListServe

•Time Management

Access and EfficiencyOverhead

•Baseline Surveys•Listserve

•Time Management•Practice Flow

Collaborative CareCoaching

•Vital Signs•Electronics

•Patient Segmentation•Self-Management Confidence

•Problem-Solving•Phone Coaching

ConfidenceWorking with Others

•Refinements of Previous Techniques•Referrals/Handoffs

Execution:TheIMP

Method

A wealth of

actionable data

• A Family of (Free) Patient/Employee/Person Assessment and Feedback Tools that:– Determine “What Matters”– Determine “What is the Matter”– Determine Preventive Needs– Determine Care Experience– Feedback Personalized Information

that Supports Additional Actions

• A Family of Reporting Tools for Practices and Hospitals that:– Automatically Summarize and

Compare Responses– Offer Customization Options

Key lessons from IMP

• Significant improvement doesn’t have to come at the cost of heavy lifting

• Simple HIT drives measurement and improvement

• Data becomes a platform for adoption of best practices

www.IdealMedicalHome.org

National collaborative

What we’re finding - positive

• Improved population health

• Improved experience of care

• Improvement is within reach of the participants

What we are struggling with

• We’re paid for unit production so we overproduce units (visits, procedures) to maintain revenue streams

• A lot of the work to improve population health is uncompensated

• It’s easy to be mislead by the promises of IT

Moving ahead

• Prospective payment models

• Shared savings arrangements

• Overcoming inertia of status quo